Myopia Control – What Works Best???
Are you or your child getting more and more short sighted by the day?
Unfortunately, at this stage in medical knowledge/technology, this is irreversible however, we can instigate treatment to slow progression.
At Mark Hinds Optometrists we have a myopia clinic where our goal of treatment is to do our best to prevent the progression of myopia.
Some children (and adults) eyes develop myopia, the percentage of which is increasing sharply. In April of 2018, Dr Hinds precented Myopia Control and Ortho-K at the Australian Vision Convention to spread awareness and express concern. Myopia prevalence is increasing around the world, even to the point of being call an epidemic by some. In some parts of Asia, 80% of the children in high school are myopic. Myopia is particularly prevalent in Australian students from Asian backgrounds. 60% of 17year old students of East Asian background, 18% of European ancestor and 30% of Australian background are short-sighted. It has become a major and rising issue of monumental importance affecting over a billion of people around the world, and it only getting worse. In the past 15 years alone, the percentage of 17-year-old Australians with myopia has risen from 20% to 30%, without a stop in sight.
Research is showing that there are methods to slow or prevent the progression of myopia. It is best to work quickly as actions work best for younger children or at early stages of myopia where the degree of myopia is less. Myopic changes are generally permanent; and don’t get better with treatment. Treatment is therefore designed to prevent the development and progression. This requires annual eye examinations starting as early through the progression as possible.
Why Care?
While myopia may be a growing phenomenon, it can be readily corrected with glasses and contact lenses; Refractive surgery can also provide a near-permanent correction. Why then is myopia control (as distinct from myopia correction) important?
The billions of people around the world who wear glasses or contact lenses (I’d assume) would be much happier if they would be less dependent on these devices – also saving billions of their dollars in the process. In addition, myopia, especially high myopia, is no benign. Myopia is associated with increased risk of retinal detachments, myopic degeneration, myopic retinopathy, posterior vitreous detachments and other serious ocular morbidity. Some compare myopia to driving without a seatbelt, there is no guarantee a bad thing will happen but if it does there is a greater risk.
Most importantly, myopia control is becoming possible. Once thought of as almost solely a product of genes is now known to linked to environmental causes. While myopia rates continue to increase globally, we must ask; What global change/s in the human environment is driving this?
Answer – The ever growing demand of near vision demands from books, computers, TV, phones (etc.), The onslaught of these strenuous visual activities, from early childhood through to adulthood have a tremendous effect on how eyes develop.
Additionally, there is a high correlation to lack of UV light exposure (outside activities) and myopia progression. Based on Ian Morgans (a myopia researcher at the Australian National University in Canberra) epidemiological studies, estimates that children need to spend around three hours per day under natural light levels or at least 10,000lux to be protected against myopia. This is about at the level experienced by someone sitting under a tree, with sunglasses, on a bright and sunny day. For comparison an overcast day can provide less than 10,000 lux and a well-lit classroom or office is no more than 500 lux.
THE BOTTOM LINE
Myopia prevalence is increasing rapid around the world. Research in animal models has shown that axial elongation can be triggered by hyperopic blur in the peripheral retina. The explosion of near-vision tasks to which children are being increasingly subjected to is thought to be behind the rising rates of myopia.
Both pharmaceutical intervention and overnight Ortho-K have proven to be effective in slowing myopia progression in children. Due to both safety and efficacy, there are many good reasons as to why optometrists and ophthalmologists are considering adopting Ortho-K in their practices. Atropine in a low concentration eye drop (0.01%) has also shown to slow the progression of myopia/near-sightedness by 61% of users.
Mark Hinds Optometrists’ Approach
As a practice experienced in orthokeratology armed with extensive fitting sets and hundreds of patients in this modality of wear, we aim to find the best possible treatment tailored to each patient. Dr Hinds has lectured at international conferences and has been teaching at universities with many features on myopia since 2003. We are also active members of the Orthokeratology Society of Oceania. With this experience and evidence-based medicine we firmly believe that this is often an effective approach to myopia progression prevention/myopia control.
We will measure and monitor the ocular axial length as we have both a Zeiss IOL Master and OCT biometry. It is not only important to look at refractive error change but the fundamental underlying reason for this change – axial length!
References
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7. Tan DT, Lam DS, Chua WH, et al and the Asian Pirenzepine Study Group. One-year multicenter, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia. Ophthalmology. 2005 Jan;112(1):84-91.
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10. Walline JJ, Rah MJ, Jones LA. The Children’s Overnight Orthokeratology Investigation (COOKI) pilot study. Optom Vis Sci. 2004 Jun;81(6):407-13.
11. Eiden SB, Davis RL, Bennett ES, DeKinder JO. The SMART study: background, rationale, and baseline results. Contact Lens Spectrum. 2009 Oct. http://www.clspectrum.com/articleviewer.aspx?articleID=103489. Accessed October 30, 2012.
12. Kakita T, Hiraoka T, Oshika T. Influence of overnight orthokeratology on axial elongation in childhood myopia. Invest Ophthalmol Vis Sci. 2011 Apr 6;52(5):2170-4.
13. Watt KG, Swarbrick HA. Trends in microbial keratitis associated with orthokeratology. Eye Contact Lens. 2007 Nov;33(6 Pt 2):373-7.
14. Stapleton F, Keay L, Edwards K, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62.
For more see: http://www.myopiaprevention.org/references_orthokeratology.html
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